What is the coverage and dosage of ceftriaxone for Gram-negative (Gram Negative) infections?

From the Guidelines

Ceftriaxone is a highly effective antibiotic against most Gram-negative bacteria, with a recommended adult dosage of 1-2 grams intravenously or intramuscularly once daily for most infections, as supported by the most recent guidelines 1. The typical dosing regimen for ceftriaxone in adults is 1-2 grams every 12-24 hours, with a maximum daily dose of 4 grams, as indicated in the study published in Clinical Infectious Diseases 1. Key points to consider when using ceftriaxone for Gram-negative infections include:

• Coverage: Ceftriaxone has broad-spectrum activity against many Gram-negative pathogens, including Enterobacteriaceae (E. coli, Klebsiella, Proteus), Haemophilus influenzae, Neisseria species, and some Pseudomonas species.
• Dosage: The recommended dose for pediatric patients is 50-100 mg/kg/day, not exceeding 4 grams, as stated in the Pediatrics journal study 1.
• Mechanism of action: Ceftriaxone works by binding to penicillin-binding proteins to inhibit bacterial cell wall synthesis.
• Pharmacokinetics: It has a long half-life (6-9 hours) allowing for once-daily dosing, and requires dose adjustment in severe hepatic dysfunction with concurrent renal impairment, but not in renal impairment alone.
• Safety: Monitor for hypersensitivity reactions, especially in patients with penicillin allergies due to potential cross-reactivity. It is essential to note that ceftriaxone has limited activity against Pseudomonas aeruginosa, so alternative agents should be considered if this pathogen is suspected. The duration of treatment typically ranges from 5-14 days, depending on the severity and site of infection. In summary, ceftriaxone is a valuable option for treating Gram-negative infections, with a recommended dosage of 1-2 grams once daily for most infections, and its use should be guided by local antibiograms and susceptibility patterns 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Ceftriaxone for injection may be administered intravenously or intramuscularly. The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection. For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). For the treatment of serious miscellaneous infections other than meningitis, the recommended total daily dose is 50 to 75 mg/kg, given in divided doses every 12 hours.

The coverage and dosage of ceftriaxone for Gram-negative infections are as follows:

• Dosage: 1 to 2 grams per day for adults, and 50 to 75 mg/kg per day for pediatric patients.
• Administration: Ceftriaxone can be administered intravenously or intramuscularly.
• Key points:
  • The total daily dose should not exceed 4 grams for adults and 2 grams for pediatric patients.
  • The usual duration of therapy is 4 to 14 days, but may be longer for complicated infections.
  • No dosage adjustment is necessary for patients with impairment of renal or hepatic function. 2

From the Research

Ceftriaxone Coverage for Gram-Negative Infections

• Ceftriaxone is a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 3.
• It has greater activity than first and second-generation cephalosporins against Gram-negative bacteria, but less activity against many Gram-positive bacteria 3.
• Ceftriaxone is effective against various Gram-negative bacteria, including:
  • Enterobacteriaceae 3, 4
  • Haemophilus influenzae 4
  • Moraxella catarrhalis 4
  • Neisseria spp. 4
• However, its activity against Pseudomonas aeruginosa is limited, and it is not recommended as sole antibiotic therapy in pseudomonal infections 3, 5.

Dosage and Administration

• Ceftriaxone is administered intravenously or intramuscularly, with a recommended once-daily administration schedule due to its long half-life 3, 4.
• The dosage of ceftriaxone varies depending on the type and severity of the infection, as well as the patient's age and renal function 4.

Clinical Efficacy

• Ceftriaxone has been shown to be effective in treating various Gram-negative infections, including:
  • Urinary tract infections 3, 4
  • Lower respiratory tract infections 3, 4
  • Skin and soft tissue infections 3, 4
  • Bone and joint infections 3, 4
  • Bacteraemia and sepsis 3, 4
• Ceftriaxone has also been used as an alternative to standard therapy for the treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections 6.